VALUE OF URINARY SEDIMENT IN THE DIAGNOSIS OF INTERSTITIAL REJECTION IN RENAL TRANSPLANTS1

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Abstract
The occurrence of lymphocyturia, or a sharp increase in preexisting lymphocyturia, has been found to correlate with immunological rejection. In most studies time-consuming staining techniques or counting chambers have been used. A new staining technique, with prestained slides, is investigated as a predictor of cellular rejection and to distinguish between cellular rejection and cyclosporine (CsA) toxicity, or other causes of renal function impairment. In 18 consecutive renal transplant recipients, treated with CsA, urinary sediments were analyzed almost daily for two months, and prediction of cellular rejection was related to renal biopsies and retrospective clinical evaluation. In addition 24 transplant biopsies were compared with urinary sediment prediction; in both parts of the study a lymphocyturia of more than 20% and polymorphs less than 55% (of 100 nucleated cells, excluding squamous epithelial cells) were considered to suggest interstitial rejection. Episodes of lymphocyturia (>20%), with simultaneous increase of the number of epithelial cells, resulting in a relative decrease of polymorphs (<55%), were found 10 times. Of these, 9 corresponded well with biopsy or clinical evaluation and 1 was false-positive. Correlating urinary sediment analysis with biopsy histology (n = 24), 19 were accurate, 3 equivocal, and 2 false; this corresponds to a sensitivity of 77% and a specificity of 91%. In conclusion, the analysis of urinary sediments with prestained slides is a quick and simple method to diagnose cellular rejection and to distinguish it from toxic or ischemic renal damage. Results are comparable to those of the fine-needle aspiration technique without invasive insult to the patient.